Lesson 20: Common Injuries and Emergency Procedures Flashcards
What is a muscle strain?
Injuries in which the muscle works beyond its capacity, resulting in microscopic tears of the muscle fibers.
What might a client feel in a mild muscle strain and severe muscle strain?
In mild strains, the client may report tightness or tension.
In severe strains, the client may report a sudden ‘tear’ or ‘pop’ that leads to immediate pain and weakness in the muscle.
What will occur following a muscle strain?
Swelling, discoloration (ecchymosis) and loss of function.
What are the 3 grades to a muscle strain?
Grade 1 - a mild strain where a few muscle fibers are stretched or torn. Injured muscle is tender, painful and may experience localized spasms.
Grade 2 - a moderate sprain where a large number of fibers are stretched/torn. More severe muscle pain, tenderness, swelling and noticeable loss of function + bruising.
Grade 3 - complete tear where there is complete loss of muscle function, severe pain, swelling, tenderness, discolouration and palpable defect.
What is ecchymosis?
Discolouration of the skin due to bleeding underneath - seen as bruising.
What is a hamstring muscle sprain often caused by and what are the risks of this?
They are caused by a severe stretch or rapid, forceful contraction such as sprinting.
The risk factors of this injury are poor flexibility, poor posture, muscle imbalance, improper warm-up and training errors.
What is a hip muscle strain caused by, how might it feel and what is the risk factor of this injury?
A hip strain is common in ice hockey/figure skating that require explosive acceleration/deceleration and change in direction with a lateral movement.
They may feel an initial pull of the inside thigh muscles followed by intense pain and loss of function.
The risk factor is a muscular imbalance between the hip abductors and adductors.
What are calf muscle strains most common in and what are the risk factors of this injury?
Calf strains are most common in athletes that participate in running/jumping sports. Risk factors include muscle fatigue, fluid and electrolyte depletion, forced knee extension while the foot is dorsiflexed and forced dorsiflexion when the knee is extended.
What are the most common joints for ligament sprains?
ankle, knee, thumb/finger, shoulder
What should a client expect when they experience a ligament sprain?
A ‘popping’ sound followed by immediate pain, swelling, instability, decreased ROM and loss of function.
What types of ligament sprains are of particular medical significance?
Injuries to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) of the knee.
What are the 3 grades to ligament sprains?
Grade 1 - microscopic tearing of collagen fibers with minimal swelling and tenderness
Grade 2 - complete tear of some collagen fibers with moderate tenderness, swelling, decreased ROM and possible instability
Grade 3 - complete tear/rupture of the ligament with significant swelling, tenderness and instability
What are the acute care actions for each grade of a ligament sprain?
Grade 1 - RICE (rest, ice, compress, elevate)
Grade 2 - RICE + physical evaluation
Grade 3 - Immobilization with air splint, RICE, prompt physical evaluation
What is the primary role of the Anterior Cruciate Ligament (ACL)?
To prevent anterior glide of the tibia away from the femur.
What is the common mechanism of injury when someone injures their ACL?
Sudden deceleration of the body with a twisting, pivoting or side-stepping movement.
What is the primary role of the Medial Collateral Ligament in the knee?
To prevent medial bending (valgus) on the knee.
What are 3 common overuse conditions?
- tendinitis
- bursitis
- fasciitis
What is tendinitis? What is it usually caused by?
Inflammation of the tendon that is usually caused by starting new activities/programs too quickly and the tendon not handling the new level of demand, resulting in irritation that triggers an inflammatory response.
What is Bursitis? What is it usually caused by?
An inflammation of the bursa sac due to acute trauma, repetitive stress, muscle imbalance or muscle tightness on top of the bursa.
What are bursae/bursa sac’s?
small fluid-filled sacs that reduce friction between moving parts in your body’s joints.
What is fasciitis? Where is it commonly found?
Inflammation of the connective tissue called fascia, commonly seen in the bottom and back of the foot.
Damage to the joint surface of the knee often involves damage to what 2 cartilages?
- hyaline cartilage - covers the bone
2. menisci cartilage - acts as a shock absorber
Which is the most commonly reported knee injury?
Damage to the menisci cartilage.
When someone has a meniscal tear, what might they complain of?
Stiffness, clicking or popping with weight-bearing activities, giving away/catching/locking in, joint pain, swelling and muscle weakness.
What is chondromalacia?
A softening or wearing away of the cartilage behind the patella, resulting in inflammation and pain.
What is chondromalacia associated with?
Improper training methods, sudden changes in training surface, lower-extremity muscle weakness and/or tightness, foot overpronation.
What might the affected knee in chondromalacia appear as?
warm, swollen, with pain occurring behind the patella during activity.
What is the patella also known as?
The kneecap
What are the signs and symptoms of a stress fracture?
- progressive pain that is worse with weight-bearing activity
- focal pain
- pain at rest in some cases
- local swelling
What are the 4 types of stress fractures?
- longitudinal
- oblique
- transverse
- compression
What are the 3 phases of healing?
Phase 1 - inflammatory
Phase 2 - fibroblastic/proliferation
Phase 3 - maturation/remodelling
How long does the inflammatory phase of healing last and what is its focus?
This can last up to 6 days and focuses on immobilizing the injured area. Increased blood flow occurs to bring in oxygen and nutrients to rebuild the damaged tissue.
How long does the fibroblastic/proliferation phase of healing last and what is its focus?
This begins approximately at day 3 and ends at day 21 of the healing process.
Beings with filling the wound with collagen and other cells which eventually forms a scar. The wound can resist normal stresses and continues to build strength for several months.
How long does the maturation/remodelling phase of healing last and what is its focus?
Begins at approx day 21 and can last for up to 2 years.
This begins to remodel the scar, rebuild the bone and/or strengthen the tissue into a more organized structure.
What are the signs and symptoms of tissue inflammation?
- pain
- redness
- swelling
- warmth
- loss of function
What is the most important question a trainer must ask themselves before starting with a client with pre-existing injuries?
Is the client appropriate for exercise or should they be cleared by a medical professional?
What are some common symptoms of post-injury/post-surgery overtraining?
- soreness that lasts for more than 24 hours
- pain when asleep
- soreness/pain that occurs earlier or is increased from a prior session
- increased stiffness/decreased ROM over several sessions
- swelling, redness, warmth in healing tissue
- progressive weakness over several sessions
- decreased functional usage
What are the actions of RICE?
- rest or restricted activity (especially weight-bearing activities, until cleared by a physician)
- ice should be applied every hour for 10-20 mins until swelling/tendency has passed
- compression is placed on the area to minimize local swelling
- elevation of the area 6-10 inches above the heart will help control swelling and reduce hemorrhage, inflammation, swelling and pain.
What are contraindications to stretching that need to be considered to prevent injury?
- fracture site that is healing
- acute soft-tissue injury
- post-surgical conditions
- joint hypermobility
- area of infection
- hematoma/indication of trauma
- pain in affected area
- restrictions from clients doctor
- prolonged immobilization of muscles/connective tissue
- joint swelling from trauma/disease
- presence of osteoporosis or rheumatoid arthritis
- history of prolonged corticosteroid use
What is effusion?
Joint swelling
Which joint of the body has the largest ROM?
shoulder / glenohumeral
Anatomically the shoulder joint consists of a shallow articular surface, what can this easily cause?
instability between the acromion and humeral head
What is the difference between a sprain and a strain?
A sprain often involves a ligament whereas a strain involves a tendon
Who is shoulder impingement particularly commonly seen in?
Those that participate in overhead activities such as tennis, baseball, swimming.
What is shoulder impingement?
when inflammation causes the tendons, muscles, or bones to push into the bursa or against each other.
What are signs of shouler strains/sprains?
Local pain at the shoulder that radiates down the arm and possible swelling, tenderness in the shoulder that causes pain and stiffness with the movement.
What are some examples of conservative management of common musculoskeletal injuries?
- avoiding aggravating activities or movements
- physical therapy
- modalities (ice/heat)
- oral anti-inflammatory medication
- cortisone injections
What should an exercise programme following a shoulder sprain/strain focus on?
- Regaining strength/flexibility of the shoulder complex and more specifically, strengthening the scapular stabilizers and rotator cuff muscles to restore proper scapulohumeral motion.
- Stretching the major muscle groups around the shoulder to restore proper length of muscles.
Following shoulder injuries, overhead movements are often modified, how would you modify an overhead press as to avoid injuring again?
The client should not fully extend their arms, the shoulders should be positioned more towards the front of body* to prevent impingement of shoulder structures.
- in the scapular plane where the shoulder is positioned 30 degrees anterior to the frontal plane
What are the differences between an acute and chronic rotator cuff tear?
acute - related to trauma such as falling on shoulder or raising arm against overwhelming resistance, severe loss of function.
chronic - gradual worsening of pain and weakness, result of a degenerative process in those over 40, dominant arm usually most affected.
Which gender is more susceptible to rotator cuff tears?
males
What are the signs of an acute rotator cuff tear?
The client will likely complain of feeling a sudden ‘tearing’ sensation followed by immediate pain and loss of motion.
They will have issues raising their arm above their head.
What are the signs of a chronic rotator cuff tear?
The client will show a gradual worsening with increased pain at night or after activity.
Reaching overhead or behind their back will be painful and even simple tasks like putting on a shirt will prove impossible.
What other structures within the shoulder complex are likely to be damaged in a rotator cuff tear too?
The glenoid labrum and biceps tendon.
What is the management process of a rotator cuff tear?
The client should see a physician for proper diagnosis and management, they may be referred to physical therapy and other imaging such as an MRI may be obtained for a more extensive view.
How long is a client usually immobilized following a rotator cuff tear to allow for healing?What motions will they be allowed to perform?
6-8 weeks
They will only be allowed to perform passive ROM as actively contracting the repaired muscle could cause a re-tear.
After the resting/healing period, what must a PT ensure they do when working with a client who had injured/tore their rotator cuff?
They must obtain specific exercise guidelines from the client’s physician or surgeon and continue what was done in physical therapy in a safe, progressive manner.
When working with a client post-rotator cuff injury/tear, why should you avoid overhead and straight arm exercises?
Because these will cause issues in the healing tissue, exercises with the elbows bent will create less torque on the healing muscles.
What is torque?
a measure of the force that can cause an object to rotate about an axis.
What are 2 of the most common elbow/wrist injuries?
Lateral and medial epicondylitis
What is lateral epicondylitis?
Often called tennis elbow, it is defined as an overuse/repetitive trauma injury of the wrist extensor muscle tendons near their origin on the lateral epicondyle of the humerus.
What is medial epicondylitis?
Often called golfer’s elbow, it is defined as an overuse or repetitive-trauma injury of the wrist flexor muscle tendons near their origin on the medial epicondyle.
What is the difference between a condyle and an epicondyle?
The main difference between condyle and epicondyle is that condyle forms an articulation with another bone. whereas epicondyle provides sites for the attachment of muscles.
What will clients likely complain about if they have medial/lateral epicondylitis?
Pain at the site during aggravating activities, it will diminish with rest but tends to get worse over time if not addressed properly.
In the case of elbow tendinitis, what should be avoided?
Activities/movements that include repetitive elbow/wrist flexion or extension activities.
What should the focus be of an exercise program following elbow tendinitis?
To avoid aggravating activities and improving posture/body positioning, regaining strength and flexibility of the flexor/pronator and extensor/supinator muscle groups of the wrist and elbow.
What should be avoided when following a new program after elbow tendinitis?
Full elbow extension should be avoided as it can cause excessive loading of the muscle.
High-rep activities should also be avoided at both the elbow and wrist.
What is carpal tunnel syndrome and what does it cause?
A common condition that causes pain, numbness, and tingling in the hand and arm.
What is carpal tunnel syndrome caused by?
repetitive wrist/finger flexion when the flexor tendons are strained and therefore results in a narrowing of the carpal tunnel due to inflammation, which results in compression of the medial nerve.
Who is carpal tunnel syndrome more likely to affect? (age, gender)
Women with a peak range of 40-60
What are the signs and symptoms of carpal tunnel syndrome?
It starts gradually with pain, weakness or numbness in the radial 3 1/2 digits of the hand and palmar aspect of the thumb.
As it progress other symptoms worsen such as:
- night/early morning pain/burning
- loss of grip strength
- numbness/paresthesias in palm, thumb, index and middle fingers
- loss of sensations
- atrophy of the thumb
What type of injection can be given for carpal tunnel syndrome?
Cortisone
What should exercise programming after carpal tunnel syndrome focus/watch for?
It should focus on regaining strength and flexibility of the elbow, wrist and finger flexors and extensors.
The PT should ensure the client is wearing their wrist splint during activity and monitor for increased symptoms.
Why should clients avoid full wrist flexion/extension following carpal tunnel syndrome?
Because these end range positions can further compress the carpal tunnel which can increase symptoms.
What age do women/men usually experience low back pain and what % of adults will experience it at some point? Also, what % usually ends up being chronic?
Age = 30-50
80%
30% chronic
What are some common risk factors associated with low-back pain?
- heavy lifting
- obesity
- prolonged static postures
- stress/depression
- inherited diseases
- smoking
- pregnancy
- disease like osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, cancer
What is ankylosing spondylitis?
It is an inflammatory disease in your back that eventually causes your vertebrae to fuse together and a ‘hunchback’ posture.
What are the most frequently sited causes of low back pain? (3)
- mechanical back pain
- degenerative disc disease
- sciatica
What is degenerative disc disease?
an age-related condition that happens when one or more of the discs between the vertebrae of the spinal column deteriorates or breaks down, leading to pain.
What is sciatica?
Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg.
What is mechanical low-back pain described as and where does the pain originate from?
Mechanical low back-pain can be described as pain that is produced with movement of specific anatomical structures. It originates from abnormalities/deviations in the vertebrae, intervertebral discs or facet joints.
Why would someone with mechanical low-back pain experience poor muscular strength and flexibility?
Due to a decrease in activity, muscle spasms, muscle tension and myofascial restrictions.
What occurs alongside Degenerative Disc Disease?
Disc herniations and bulging discs between the 4th and 5th lumbar vertebrae or between the 5th lumbar verterbae and 1st sacroiliac joint.
In degenerative disc disease and disc herniations, if the nerves coming out of the spinal cord get ‘pinched’ due to a narrowing of the foramina, what will the client develop signs of?
Sciatica or other nerve radiculopathy.
What is radiculopathy?
A pinched nerve
What type of movements should clients with low-back pain avoid?
Repeated bending or twisting movements due to the high stress caused in the spinal structures.
How should clients with low-back pain learn to stabilize the trunk?
With a moderate lordosis or neutral position.
What is the difference between lordosis and kyphosis?
Lordosis is the normal inward lordotic curvature of the lumbar and cervical regions of the human spine whereas Kyphosis is the normal outward curvature of the thoracic and sacral regions.
What is greater trochanteric bursitis?
Painful inflammation of the greater trochanteric bursa between the greater trochanter of the femur and the gluteus medius tendon/proximal iliotibial band (IT).
Who is most likely to experience Greater Trochanter Bursitis?
Female runners, cross-country skiers, ballet dancers and middle-aged to elderly adults.
What is inflammation of the bursa due to?
Acute incidents such as falling, contract sports or repetitive trauma to the area such as excessive friction from prolonged running, kickboxing or increased/changes in activities.
What are the signs and symptoms of Greater Trochanter Bursitis?
- trochanteric pain/paresthesias radiating from the greater trochanter to the posterior lateral hip and down the iliotibial tract to the lateral knee
- walking with a limp
Why might someone with Greater Trochanter Bursitis walk with a limp?
Due to pain, weakness, decreased muscle length of the quads/hamstrings, myofascial tightness in the IT band, and decreased muscular strength.
What is Trendelenberg Gait?
an abnormal gait resulting from a defective hip abductor mechanism. The primary musculature involved is weakness of the gluteal musculature, including the gluteus medius and gluteus minimus muscles that causes drooping of the pelvis to the contralateral side while walking.
What should an exercise program following Greater Trochanter Bursitis focus on?
- regaining flexibility and strength at the hip
- stretching the iliotibial band complex, hamstrings and quadriceps
- strengthening the gluteals and deeper hip rotator muscles to maintain adequate strength
- learning proper gait techniques in walking/running
What positions/activities should those with greater trochanter bursitis avoid?
Side-lying positions that compress the lateral hip and higher-loading activities such as squats/lunges.
What are general recommendations for shopping for the right athletic shoe?
- get fitted towards the end of the day as your foot may increase by half a shoe size during the course of a single day OR get fitted for your training time if it is the exact same everyday
- allow a space of the width of the index finger between your longest toe and end of the shoe
- the ball of the foot should match the widest part of the shoe
- shoes should not rub/pinch any area of the foot/ankle
- wear similar socks to that you would train in
Why is it important to be aware of when your shoes need replaced? How do you know when this is?
To avoid sustaining ankle, shin and knee injuries.
When the absorption/cushioning of the pounding/jarring action is lost, uneven wearing down at the heel, traction on the soles are worn flat.
How many miles/KM/months do athletic shoes typically lose their cushioning?
350 - 500 miles / 560 - 800 KM /
3 - 6 months
What is Iliotibial Band Syndrome?
A repetitive overuse condition that occurs when the distal portion of the IT Band rubs against the lateral femoral epicondyle.
Who is most likely to experience Iliotibial Band Syndrome and what is it caused by?
Active individuals aged 15-50.
It is caused by training errors in runners, cyclists, volleyball players and weight lifters.
What are the risk factors of Iliotibial Band Syndrome?
- overtraining
- improper footwear/equipment use
- changes in running surface
- muscle imbalance
- structural abnormalities
- failure to stretch correctly
What are signs and symptoms of iliotibial band syndrome?
- gradual onset of tightness, burning or pain at the lateral aspect of the knee
- pain radiating from the lateral aspect of the knee to the outside of the knee and/or up the outside of the thigh
- stabbing/sharp pain along the lower outside of knee
- snapping/popping sensation felt at the lateral knee when flexed/extended
Why can iliotibial band syndrome cause a limp?
Because there may be weakness in the hip abductors, shortening of the IT band and tenderness throughout the IT band complex.
What exercises should be avoided/modified with clients returning to exercise after iliotibial band syndrome?
- high-loading activities such as lunges/squats should be avoided at first and added at a slower pace.
They should be limited to 45 degrees of knee flexion with a progression to 90 degrees
What is Patellofemoral Pain Syndrome?
Often called ‘anterior knee pain’ or ‘runners knee’
It is pain felt in front, behind or around your knee/kneecap
What are the 3 primary categories for causes of Patellofemoral Pain Syndrome?
- overuse
- biomechanical
- muscle dysfunction
What biomechanical abnormalities cause Patellofemoral Pain Syndrome?
- Flat foot (pes planus) can alter knee alignment, internal rotation of the tibia/femur that therefore alters the dynamics of the patellofemoral joint.
- High arches (pes cavus) can also cause less cushioning of the foot and cause excessive stress on the patellofemoral joint.
What muscle dysfunctions have been associated with Patellofemoral Pain Syndrome?
- tightness in the Iliotibial Band Complex causes excessive lateral force to the patella.
- tightness in the hamstrings can cause a posterior force to the knee and increased contact between the femur and patella
- tightness in the gastrocnemius/soleus complex leads to pronation during walking and excessive posterior forces
- hip abductor/external rotator weakness can cause femoral internal rotation and abnormal knee valgus which can cause abnormal patellofemoral tracking
What are the signs and symptoms of Patellofemoral Pain Syndrome?
- Pain when running, ascending/descending stairs, squatting or prolonged sitting.
A gradual ache behind/underneath patella
What is recommended to manage Patellofemoral Pain Syndrome?
- avoiding aggravating activities such as running, deep squats, prolonged sitting
- modifying training variables
- proper footwear
- physical therapy
- knee bracing
- foot orthotics
- oral anti-inflammatories
- modalities (ice/heat)
- education
What is the focus of an exercise program following Patellofemoral Pain Syndrome or Infrapatellar Tendinitis?
Restoring proper flexibility by addressing tightness in the iliotibial band complex, hamstrings, calves.
Restoring strength throughout the hip, knee and ankles to help control forces imposed on the knee joint and stability.
What exercise modifications should be made in the presence of injury and Patellofemoral Pain Syndrome?
Exercising in the mid-range (45 degrees) of closed-chain activities as open-chain activities place abnormal stress on the patella.
A client exhibits Patellofemoral Pain Syndrome and injury, instead of doing leg extension, what modification could you make and why?
Perform single straight-leg raise in a sitting/supine position to challenge the quadriceps without imposing patella stress.
What is Infrapatellar Tendinitis?
‘jumpers knee’
it is an overuse syndrome characterized by inflammation of the patellar tendon at the insertion into the distal part of the patella and proximal tibia.
What causes Infrapatellar Tendinitis?
Improper training methods, sudden change in training surface, lower-extremity inflexibility and muscle imbalance.
why is infrapatellar tendinitis common in sports such as basketball, volleyball and track?
because of jumping aspects that produce significant strain in the tendinous tissues
What are signs of Infrapatellar Tendinitis?
pain at the distal kneecap into the infrapatellar tendon
Where is the Patellar Tendon?
It attaches the bottom of the knee (patella) to the top of the shinbone (tibia)
How can you manage Infrapatellar Tendinitis?
- avoid aggravating activities like running, plyometrics, prolonged sitting
- modifying training variables
- proper footwear
- physical therapy
- patellar taping
- knee bracing
- arch supports
- foot orthotics
- client education
- oral anti-inflammatory medication
- modalities (ice/heat)
A client exhibits Infrapatellar Tendinitis, what exercise modification would you make to jogging to ease them back in?
Have them first jog on a trampoline before progressing to grass and then a court/harder surface.
What are shin splints classified as?
Either medial tibial stress syndrome/posterior shin splints or anterior shin splints.
What is Medial Tibial Stress Syndrome caused by?
MTSS is an overuse injury usually triggered by a sudden change in activity or due to pes planus (flat foot).
What is Medial Tibial Stress Syndrome?
Also known as Posterior Shin Splints or Periostitis which is inflammation of the periosteum (connective tissue covering the bone.)
What areas are affected by Anterior Shin Splints?
Usually the anterior compartment of leg muscles, fascia and periosteal lining.
What are signs of Posterior/Anterior Shin Splints or Medial Tibial Stress Syndrome?
Posterior/MTSS = a dull ache along the distal 2/3 of the posterior medial tibia. Anterior = same dull ache along distal anterior shin
How do you manage shin splints?
- Modify training with lower-impact and lower-mileage conditioning/cross training.
- Rest may be better advised.
- Modalities (ice/heat)
- Oral anti-inflammatories
- Cortisone injections
- Heel pads
- Bracing
- Physical therapy
What is the focus of an exercise programming following shin splints?
To get the client back to full unrestricted activity without exacerbating the symptoms. Cross-training can maintain levels of fitness and stretching/strengthening can relieve symptoms.
Why should a lower-body stretching program accompany more specific stretching in the case of shin splints/MTSS?
To address any secondary muscle-length deficits and imbalances that may affect the foot/ankle.
especially the calf and anterior leg muscles
Literature reviews reveal that ankle sprains account for approx __ to __ % of all athletic injuries.
20 - 40%
What is the most common type of ankle sprain?
Lateral or inversion.
What are the lateral ankle ligaments usually involved in ankle sprains?
- anterior talofibular ligament ATFL
- calcaneofibular ligament CFL
- posterior talofibular ligament PTFL
What is the mechanism of injury in lateral ankle sprains?
The mechanism of injury is typically inversion with a plantar flexed foot.
What are medial or eversion ankle sprains a result of? What structure is involved?
Forced dorsiflexion and eversion of the ankle.
This involves the medial deltoid ligament.
What are signs of a medial ankle sprain?
Discomfort when dorsiflexing and everting the ankle, medial swelling with tenderness over the deltoid ligament.
What muscles might exhibit tightness or immobilization following ankle sprains?
Gastrocnemius and soleus muscles and therefore Achilles Tendon
Which type of ankle sprain is not common and usually follows after some kind of trauma?
Eversion - usually follows a fracture
What muscle group should be targeted for inversion ankle sprains to prevent re-injury?
The peroneal muscle group (peroneus longus, brevis and tertius.)
In the presence of ankle injuries, what directional motions should PT’s first start with and progress to?
They should begin with straight-plane motions such as forward running, then side-to-side motions such as sidestepping and then multidirectional motions such as carioca.
What are the intrinsic factors associated with Achilles Tendinitis?
- age
- pes cavus
- pes planus
- leg-length discrepancies
- lateral ankle instability
What is Pes Cavus and Pes Planus?
Pes Cavus = high arch
Pes Planus = flat foot
What are the extrinsic factors associated with Achilles Tendinitis?
- errors in training
- prior injuries
- poor footwear
- muscle weakness
- poor flexibility
What are the signs of Achilles Tendinitis?
Pain that is 2-6 cm above the tendon insertion in to the calcaneus (heel.)
It is typically sharp in the morning and increases with vigorous activity.
What is the management of Achilles Tendinitis?
Controlling pain and inflammation by using modalities, rest, oral anti-inflammatories and preventing progression of the condition by utilizing proper training techniques, weight loss, proper footwear, orthotics, strengthening, stretching.
What can occur if Achilles Tendinitis is no seen to?
A rupture
Why might restoring proper length to the calf muscles help Achilles Tendinitis?
As it can reduce strain to the musculotendinous unit and decrease symptoms.
Can Isometric or Eccentric exercises reduce pain and improve strength in the presence of achilles tendinitis?
Eccentric
What is a key component to managing Achilles Tendinitis?
Regaining calf flexibility
When stretching your calf with Achilles Tendinitis, what should the client be cautious of?
Keeping their foot in a neutral position to avoid excessive pronation/supination to assume the target muscle is stretched.
What is Plantar Fasciitis?
An inflammatory condition of the plantar aponeurosis of the foot.
What is the plantar aponeurosis?
also known as the plantar fascia, it is a strong layer of white fibrous tissue located beneath the skin on the sole of the foot.
What is the most common cause of heel pain and heel spur formation?
Plantar Aponeurosis
Who is Plantar Aponeurosis most common in?
Obese individuals and people one their feet for long periods of time
What intrinsic and extrinsic factors are associated with Plantar Aponeurosis?
Intrinsic:
- pes planus
- pes cavus
Extrinsic:
- overtraining
- improper footwear
- obesity
- unyielding surfaces
What are signs of Plantar Aponeurosis?
Pain in the medial side of the heel that is most noticeable with initial steps after a period of inactivity. Pain tends to worsen as the day goes on but lessens with increasing levels of activity.
How do you manage Plantar Aponeurosis?
- modalities such as ice
- oral anti-inflammatories
- heel pad/plantar arch
- stretching
- strengthening exercises
- night splint
- physical therapy
- cortisone injections
- orthotics
What is the goal of an exercise program surrounding Plantar Aponeurosis?
To design a program that challenges the client but does not excessively load the foot. It should integrate specific foot exercises.
Stretching of what muscles and which techniques will help alleviate plantar aponeurosis?
Stretching of the gastrocnemius, soleus and plantar fascia.
Self-myofascial release techniques such as rolling the foot over a baseball, dumbell to enhance ROM in the plantar fascia.
What will strengthening the foot’s intrinsic muscles help improve/decrease in the case of Plantar Aponeurosis?
It will help improve arch stability and decrease the stressed imposed across the plantar fascia.
Strengthening of what muscles will help improve strength at the ankle?
Gastrocnemius, soleu, peroneals, tibialis anterior and tibialis posterior.
How can you isolate the plantar fascia for a more effective stretch?
Bend the toes with your hands or against a wall.
How often should a PT update a client’s medical history?
Every 3 months
Why might noting a client’s present conditions especially prior to an exercise program help the PT in future?
Because it will provide a baseline to compare back to which can provide motivation and goal development.
What are the steps a PT must follow when a client experiences an injury during a workout session?
- Immediate medical attention including minor first aid or activation or emergency medical services.
- A formal written account of the incident
- PT must keep their own account of what occured and maintain any relevant documentation
What must a PT obtain before discussing client medical records with an outside party according to the 1996 Health Insurance Portability and Accountability Act?
They must obtain written permission from the client.
What is the emergency protocol if you have not witnessed the sustained injury?
- assess the scene - are you safe?
- conduct a primary assessment - is it life threatening? Check airway, breathing + circulation
- perform CPR as assessed
What are the ABC’s when checking a client’s injury?
Airway
Breathing
Circulation
When is Automated External Defibrillation used?
To determine the client’s heart rhythm and determine if shock is needed.
If yes, it will re-establish normal heart rhythm.
Also guides the administrator of CPR.
If a situation is not immediately life threatening, what should you do?
- perform secondary assessment
- if conscious, ask for feedback of injury
- if unconscious, perform a head-toe assessment, check for tenderness/swelling and look for medical alert jewelry
In a life-threatening situation regarding a client, what must you do?
- call 999 to activate emergency medical services
What situations would require you to call 999 in regards to a client injury?
- unresponsiveness to voice or touch
- chest pain or discomfort
- trouble breathing
- signs of a stroke
- traumatic injury or burn
- seizure
- sudden paralysis
- electric shock
- exposure to poison
What are 2 common heat illnesses?
Heat stroke and heat exhaustion
When do muscle strains occur?
When the muscle and tendons that attach it to the bones work beyond their capacity and microscopic tears occur.
What is a meniscus injury?
The meniscus is cartilage between your femur and tibia (thigh and shin,) a torn meniscus occurs because of trauma caused by forceful twisting or hyper-flexing of the knee joint.
What is chondromalacia?
The wearing away of the cartilage behind the patellar
What type of injury requires immediate care?
Acute injuries
What should you do if a client exhibits an overuse injury during a program?
Decide if the program requires modifications or if they need to be referred to a physician.
What is the PRICE response to acute injuries?
Protection/splint Rest/restricted activity Ice Compression Elevation/ 6-10 inches above level of heart
What might cause temporary muscle soreness?
New participation in activity such as painting a room over the weekend or a sudden 10km run.
What will a client complain of with temporary muscle soreness and what should you do?
They will complain of local discomfort to the area and you should modify the program with stretching of the area or rest to address the issue.
What exercises would be most important to include for a client who has recovered from Achilles Tendinitis and wants to prevent it from returning?
Eccentric strengthening for the calf complex through controlled dorsiflexion against gravity and stretching the calf muscles.
What personal protective equipment might a trainer need to wear when administering first aid?
- gloves
- eye protein
- mask
What will wearing a mask in emergency situations prevent?
The spreading and transferring of pathogens which are microorganisms that cause disease.
What are 2 bloodborne diseases of most concern to a personal trainer?
Human immunodeficiency virus (HIV) and hepatitis
Scene safety requires knowing when it is safe to approach a victim, what are some dangerous situations that would prevent you approaching?
- road accidents in which you might be struck by a vehicle
- smoke-filled buildings
- downed power lines
- hazardous materials
- crime in progress
- unstable surfaces
What should a first-aid kit maintain and stock for airway management?
CPR microshield or pocket mask with one-way valve for protected mouth-mouth ventilations
What does a mouth to mask ventilation mask prevent?
Contact with the victim’s face during mouth to mouth resuscitation and therefore lowered risk of transfering pathogens
What should a first-aid kit maintain and stock for assessing circulation?
- sphygmomanometer (blood pressure monitor/cuff)
- stethoscope
- penlight or flashlight
What should a first-aid kit maintain and stock for general wound management?
- personal protective equipment (latex gloves, mask, eye protection)
- sterile gauze dressings
- adhesive tape
- bandage scissors
- liquid soap or hand sanitizer
What should a first-aid kit maintain and stock for suspected sprains or fractures?
- splinting materials
- chemical cold pack/ice and plastic bag
- compression wrap
What steps should a fitness facility take to minimize the risk of injuries?
- all employees must be trained in first aid, CPR and AED usage.
- fitness staff should hold current certifications in their specialty areas
- adequate lighting
- non-slip surfaces around showers and pools
- caution signs for wet floors/hazards
- regular maintenance of equipment
- clean drinking water supply
- fire/smoke alarms
- limiting number of people to avoid overcrowding
- easily accessible phones
- maintained first-aid kits
What is the physical activity readiness questionnaire (PARQ) and why should fitness facilities administer it?
This is a simple screening questionnaire to identify those at high risk for cardiovascular events and those that need medical referral or modifications to exercise programs.
It can also help identify the need for additional qualified staff members if there are a number of high-risk clients.
What should a facilities emergency action plan involve that they teach to all employees?
- It should include instructions on how to handle the most likely emergencies such as hypoglycemic events, cardiac events, strokes, heat illnesses and orthopedic injuries.
- Fire drills should also be rehearsed.
- The staff should understand the difference between first, second and third responders and know the locations of first-aid kits, AED, phones, emergency exits and most accessible route for emergency personnel.
- Someone at the facility will be identified as the coordinator for handling an emergency.
When should you not move a victim in an emergency situation?
When they have head or neck injuries UNLESS there is a danger of further injury if the victim is not moved.
When trained help is needed with a single victim, what should you do?
One staff member should stay with the victim whilst another runs to call the emergency medical services and guide them to the scene. If there is a third staff member they should get the first-aid kit and AED.
What should be included in an incident report?
- name of the victime
- date and time of the incident
- what happened
- what was done to care for the individual and by whom
- names, numbers and addresses of witnesses
You are the first responder to an emergency, what is the first thing you should do?
Ask if the victim is okay and if they can hear you, introduce yourself and ask what the problem is and if you can help.
You are the first responder to an emergency, after asking how the victim is, they reply. What does this tell you and what is your next step?
This tells me that there is a patent airway and that they are breathing, conscious and have a pulse.
Ask if you can check for blood anywhere coming out of their body.
You are the first responder to an emergency and the victim appears unresponsive. What do you do?
As they are unconscious, you must call emergency medical services or ask someone else to.
Implied consent is also given and you check the ABC’s (airway, breath, circulation.) If there is no sign of trauma to the spine, perform a head tilt-chin lift to open the airway and remove the tongue for resting at the back of the throat which will block the airway.
If there is evidence of a fall or trauma to the face/neck/head, open the airway by the jaw thrust method instead.
You are the first responder to an incident, how would you assess the victim’s respirations?
Have an ear close to the victim’s mouth to feel for breath on your cheek and listen for air movement whilst watching to see if their chest rises and falls. This should be done for 5-10 seconds.
You are the first responder to a scene, the victim is not responsive, you have checked the ABC’s but you feel no breath and their chest is not rising. What do you do?
Pinch their nose and give two breaths into the mouth to expand their lungs. Check for a pulse in 10 seconds.
Where is the carotid artery located?
Beside the trachea in front of the neck.
Where and how do you check for a pulse?
You check at the carotid artery which is located beside the trachea in front of the neck.
Press gently with 2 fingers for 10 seconds or less.
You are the first responder to a scene, the victim is unresponsive, unconscious, not breathing and you can’t find a pulse. What do you do?
Start performing chest compressions for CPR.
You are the first responder to a scene, the victim is unresponsive, unconscious, not breathing and you can’t find a pulse. They are bleeding heavily out of a part of their body, what do you do?
Start performing chest compressions for CPR and ask someone to control the bleeding with gauze pads and direct pressure.
If no one else is there, focus on CPR and only try to control the blood if it appears life-threatening.
You are a first responder to a scene, you have completed your primary assessment and they are now conscious and able to speak. What should you first check for as part of your secondary assessment?
Check for any issues that are not immediately life-threatening or are immediately life-threatening.
This involves a head-to-toe assessment for additional injuries such as deformities, abrasions, tenderness or swelling.
Also look for medical alert jewelry.
You are a first responder to a scene, you have completed your primary assessment and checked for any other life-threatening injuries/causes and medical alert jewelry as part of the secondary assessment.. What should you now check?
The victims vital signs such as pulse, blood pressure, skin colour and temperature as well as medical history (medications, allergies, symptoms) and the type/location of their pain and if they recall events leading up to the incident.
What does warm, pinkish toned skin tell you versus grayish, pale skin?
Warm, pinkish skin will signify that the client has adequate blood flow and oxygenation whereas grayish, pale skin can indicate poor circulation.
You are the first responder to a scene, you have performed a primary and secondary assessment and the victim is talking and breathing. What do you do?
Keep the victim talking and make them aware of what is happening whilst continuing to monitor their airways and injuries until emergency medical services get there.
What are some examples of situations in which you should phone 999?
When a victim:
- does not respond to voice/touch
- has chest pain/discomfort
- has signs of stroke
- has problem breathing
- has a severe injure of burn
- has a seizure
- suddenly cannot move a part of their body
- has received an electric shock
- tries to commit suicide/is assaulted
- there’s a crime in progress
- when the fire/smoke/carbon monoxide alarms sound in a building
- electrical hazards, fire, traffic accident, chemical spill
If a client hurts themselves but it is not necessarily an emergency, what do you do?
Call their emergency contact.
Why is it better to use a landline over a cell phone to contact emergency medical services?
Because a landline is more easily located.
What are the dispatch centers called that receive 999 calls?
Public Safety Answering Points
What as a bill passed to create a plan that will improve the 911 system from analog to digital?
To match newer technology and incorporate internet protocol (IP) network technology into the emergency system to allow for better connections and faster communication between PSAPs, responders and emergency warning systems,
Why should you collect medications for emergency responders to take in the case of rescuing a victim?
Because this can give valuable information regarding the person’s medical history and they may need the medication whilst in hopsital.
What questions are likely to be asked when phoning 999?
- what is the emergency?
- where is your emergency and what number are you calling from?
- what is your name?
- is the victim conscious?
- is the victim breathing normally?
- are you able to assist with CPR?
- do you have access to an AED?
How long does it take for brain death to occur?
4 - 6 minutes
What is cardiac arrest?
The cessation of heart function, when the person loses consciousness, has no pulse and stops breathing.
Someone that has suffered cardiac arrest is gasping, snorting or gurgling - what do you do?
Start CPR because this is not breathing and call emergency medical services.
What is the Chain of Survival for cardiac arrest victims? What does each of the 4 stages help?
- Early access: early recognition of emergency and immediate activation of emergency medical services
- Early CPR: to help the body maintain perfusion (blood flow/oxygen delivery to body tissues)
- Early defibrillation: to restart regular heart rhythms
- Early advanced care
When should CPR ideally begin with the onset of cardiac arrest?
Within 2 minutes
At what % does a person’s chance of survival decline every minute with no treatment for cardiac arrest?
10%
What a collapse due to sudden cardiac arrest occurs, why does CPR help immediatly?
Because the victim’s blood still contains oxygen and oxygen remains in the lungs therefore by pumping the chest, this allows oxygenated blood to be distributed around the body and prevents the heart from deteriorating into an unshockable rhythm.
Ventricular Fibrillation is the most common rhythm during cardiac arrest, what is it?
It is a spasmodic quivering of the heart that is too fast to allow the heart’s chambers to adequately fill and empty to little to no blood is pushed out to the body or lungs.
What is an AED used for in cardiac arrest?
To convert the heart back to regular rhythm by delivering an electric shock to the heart through adhesive electrode pads on the person’s chest.
When an AED shock is provided within the first minute of cardiac arrest, what is the survival rate?
90%
When a shock is delivered, the heart’s _____ (_____ _____) is able to restart.
pacemaker (sinoatrial node)
Who should an AED not be used on?
An infant under the age of 1 or a person who is conscious, breathing or has a pulse.
What is granted to anyone in the US who acquires an AED or uses one in a medical emergency? Why?
a Good Samaritan protection is granted to legally protect the person from any liability fears.
What is Dyspnea and when might it occur in a fitness setting?
Dyspnea is difficulty breathing and labored breathing and can come on suddenly and cause distress for the client.
Causes:
- an unconditioned client tries to exercise vigorously
- a trauma such as a blow to the chest in boxing or a barbell is dropped on the chest
- asthma
- emotional stress
- airway obstruction
- heart problems if the heart is not pumping enough blood to oxygenate the tissues properly
Why would a barbell dropping on a client’s chest during bench press cause Dyspnea?
The drop of a barbell causes air to escape the lungs into the pleural space. The high pressure this causes outside the lungs reduces lung volume and the person can experience severe breathing difficulties.
What are the 4 grades on the Dyspnea scale?
+1 - mild, noticeable to the exerciser but not to the trainer
+2 - mild, some difficulty that is noticeable by all parties
+3 - moderate difficulty, client can continue exercise
+4 - severe difficulty, client must stop exercising
What does the respiratory rate for adults average between?
12 - 20 breaths per minute
What happens when breathing is too fast such as an anxiety or panic attack?
The lungs do not have time to fill between breaths so oxygen exchange is insufficient.
What does inappropriate depth/shallow breathing indiciate?
An inadequate tidal volume or too little air inhaled with each breath.
What are the outward signs of respiratory distress?
- poor movement of the chest wall
- flaring of the nostrils
- straining of the neck muscles
- poor air exchange from the mouth and nose
- pale, diaphoretic (sweaty) skin
What are two late signs of respiratory distress?
- cyanosis (bluish colour around lips/nose/fingernails/inner lining of eyes)
- client becoming restless, agitated, confused and unresponsive
Whilst looking for a rising chest and feeling for breath on your cheek, what other sign should you look for when a client becomes unconscious?
You should listen for unusual sounds that may indicate a partial airway blockage such as snoring, gurling or a high pitched ‘crowing’ that is caused by swelling of the larynx.
What does apneic mean?
Someone who is experiencing a temporary cessation of breathing called apnea.
In what position should someone with breathing difficulties wait for emergency services to arrive?
Sitting up or in a tripod position (sitting up, leaning forward using hands for support) as lying down may increase the difficulty of breathing.
How do you tell the difference between a mild blockage and a severe blockage when someone is choking?
A mild blockage will still allow some air to get through - the client will still be able to cough and make noises.
A severe blockage will not allow any breath or sounds apart from a very quiet cough, a child won’t be able to cry either.
In a severe case, the person may signal the choking sign.
What should you do if someone is choking and becomes hypoxic?
This means they are in an oxygen deficit and you should call EMS.
What should you do if someone is choking? What do you do if the victim is large and/or pregnant?
Stand behind the victim and wrap both arms around their waist, make a fist with one hand and put the thumb side just above their belly button. Grab the fist with your other hand and perform several upward thrusts to compress the diaphragm and force the object out of their airway.
If the victim is larger, ask them to kneel.
If the victim is pregnant or too large, wrap your arms around their breastbone instead of the abdomen.
What is the Heimlich Maneuver?
a first-aid procedure for dislodging an obstruction from a person’s windpipe in which a sudden strong pressure is applied on their abdomen, between the navel and the ribcage.
What do reliever medications do for asthma?
They dilate the bronchial muscles and reduce inflammation.
How does exercise-induced asthma or exercise-induced bronchospasm occur during exercise?
The smooth muscles of the bronchioles constricts and mucous production increases, constricting the airways.
What symptoms of EIA or EIB will appear in the first 5-8 minutes of an attack but resolve usually around 30-60 mins later?
coughing, shortness of breath, wheezing, chest tightness
What is plaque made of?
Fat, cholesterol, calcium and other substances that are found in the blood that can stick to the artery walls and narrow/obstruct the vessels.
How is a heart attack different to sudden cardiac arrest?
Cardiac arrest is an electrical abnormality that disrupts the heart rhythm whereas a heart attack is due to an obstruction in a coronary vessel that prevents part of the heart muscle from getting adequate blood flow and oxygen.
What is angina pectoris?
It is described as chest pressure or a squeezing feeling and can be mistaken for heartburn or indigestion. The pain can travel to one or both arms, neck, jaw, shoulder, stomach or back.
If sudden cardiac death follows a heart attack, when is it most likely to occur?
Within the first 4 hours
What are the signs of a heart attack?
Angina pectoris that travels to one or both arms, neck, jaw, shoulder, stomach or back and is accompanied by shortness of breath, nausea, cold sweat, lightheadedness.
What is the treatment that EMS administer to someone suffering a heart attack?
They will administer oxygen and nitroglycerine whilst travelling to the hospital.
What is syncope and what are the causes?
Often referred to as fainting, it is a temporary loss of consciousness due to a lack of blood flow to the brain.
Causes: sudden postural changes after blood has pooled in the legs (such as squatting for long time then standing up), violent coughing spells, neurologic/metabolic/psychiatric disorders and problems with the heart and lunges.
Syncope is usually benign but how do you know if it is life threatening?
When it occurs with exercise or is associated with palpitations, an irregular heartbeat or there is a family history of syncope associated with sudden cardiac death.
What signs will signal syncope to the trainer and what should the trainer get them to do?
When they feel a warm sensation, nausea, lightheadedness, have sweaty palms or a visual ‘grayout’
The trainer should have them sit/lie down and drink plenty of fluids to keep blood volume at adequate levels.
What are the differences between ischemic and hemorrhagic strokes and what % do each account for of all stroke cases?
An ischemic stroke is a blockage in a vessel whereas a hemorrhagic stroke is the rupture of a blood vessel.
Ischemic strokes account for 80% and hemorrhagic strokes account for 20%.
What is an aneurysm?
An aneurysm is a balloon-type bubble in the vessel at a weak spoke that can rupture if left untreated.
What is an arteriovenous malformation?
An abnormal tangle of blood vessels connecting arteries and veins, which disrupts normal blood flow and oxygen circulation.
What does The Stroke Collaborative list as the warning signs of a stroke?
- Walk
- Talk
- Reach
- See
- Feel
If the right hemisphere of the brain is affected by a stroke, what sides of the face and body will symptoms/signs appear?
If the right hemisphere is affected, the right side of face will show symptoms but the left side of body will show symptoms due to the crossover of cranial nerves.
What happens if the back of the brain is affected by a stroke?
It can impair vision
What is Tissue Plasminogen Activator (tPA) medication used for and what will it do? When should it also be administered?
It is used as a clot-busting medication for strokes and reduces the severity and speed recovery from a stroke.
It should be administered within the first 3 hours of a stroke.
Insulin is necessary after a meal to extract ______ out of the blood and into the _____ for use as energy and stored energy in the form of _______.
Insulin is necessary after a meal to extract (glucose) out of the blood and into the (muscles) for use as energy and stored energy in the form of (glycogen.)
Why can ketoacidosis come as a result of type 1 diabetes?
Because without enough insulin, the body will start to (excessively) use fatty acids for energy and result in a state of ketoacidosis.
Why are the feelings of weakness, thirst and fatigue often a result of type 2 diabetes?
Without enough insulin, the blood sugar becomes too high (hyperglycemia) and the glucose is therefore passed to the kidneys instead of passed through the blood to muscles for energy as glycogen. When passed to the kidneys, it is excreted with a lot of water and electrolytes which leaves the person weak, thirsty and fatigued.
How many grams of carbohydrates should a client that appears hypoglycemic consume?
20 - 30 grams
Ketones are the end products of fat metabolism, if they are present in a client’s urine, what will this show?
That the body is burning fat for energy instead of glucose because of a lack of insulin.
Ketones are acidic and lower the PH of the body, what adverse side effects does a ketoacidosis state show?
confusion
lethargy
sleepiness
diabetic coma
Exercise can raise body temperature by how many degrees F?
4.5 degrees F
What is heat edema?
A temporary swelling of the extremities, usually in people not acclimated to the elevated temperatures.
What are heat cramps? What can they lead to?
Spasms that affect the arms, legs and abdominal muscles due to a loss of fluid and electrolytes, therefore causing cell size to decrease and affecting cell metabolism.
Heat cramps can lead to heat exhaustion/stroke if not treated.
How do you treat heat cramps? How long should you wait to resume activity?
Rest, direct pressure to cramp and release, gentle massage, replacing fluids and electrolytes and passive stretching.
Activity can be resumed 1-2 days after symptoms have resolved.
What are signs of heat exhaustion?
weak, rapid pulse low BP fatigue headache dizziness paleness cold, clammy skin profuse sweating elevated core body temp weakness
What are signs of heat stroke?
hot, dry skin bright red skin colour rapid, strong pulse change in mental state labored breathing elevated core body temp
What should you do if you suffer heat exhaustion?
stop exercising move to a cool, well ventilated area lay down and elevate feet 12-18 inches fluids monitor temp
What should you do if you suffer heat stroke?
stop exercising remove as much clothing as possible try to cool body temp immediately fluids transport to emergency room immediately
What does salt depletion do to the body?
results in a loss of extracellular fluid, plasma volume, cardiac output and blood pressure.
What are the areas of high blood flow that ice packs should be applied to in moments of heat stroke?
the groin, axilla (armpit) and neck
The body can survive between core temperatures of ____ to ____ degrees F.
75 - 106 degrees F
What does the core and periphery of the body refer to?
Core = brain, heart, lunges abdominal organs Periphery = skin, muscles, extremities
In cold temperature, what do receptors in the skin do?
Receptors in the skin signal the hypothalamus to begin shivering to increase core body temperature.
What are signs of mild and moderate hyperthermia?
Mild: confusion dysarthria (difficulty speaking) fatigue dizziness amnesia apathy (lack of enthusiasm)
Moderate:
lethargic
hallucinations
unconscious
At what temperature will the body stop shivering?
When the body drops below 88-90 degrees F (31-32 C)
What is orthostatic hypotension?
a condition in which your blood pressure falls significantly when you stand up quickly.
Who is more at risk of frostbite?
Those with diabetes and atherosclerosis because circulation is already impaired.
What can you expect when frostbite occurs and within 24 hours of frostbite?
When it occurs, your tissues will go numb and painful. The skin will become grayish-white or yellow with a waxy appearance that is hard to touch.
Within 24 hours, you can expect blisters to form that contain clear or yellow fluid.
What does each layer o f clothing provide/protect you from?
Inner layer will wick moisture away with synthetic fabrics.
Middle layer should be used for insulation with fabrics like fleece/wool.
Outer layer should be a protective coating from elements.
Why does a seizure occur and what is it caused by?
A seizure occurs when there is abnormal and excessive electrical activity in the brain.
10% of the population will have one in their life but only 1% is due to epilepsy. Other causes are head injuries, low blood sugar, heat injury or poisons.
What is the most common general seizure?
Tonic clonic seizure or grand mal seizure
What does a general seizure look/feel like?
An ‘aura’ that is usually a smell or sound the individual experiences that indicates a seizure will occur. They will then lose consciousness and start to experience whole-body jerk movements where the muscles contract and relax, the jaw is clenched and their bowel/bladder control can be lost.
What is the postictal state?
The state of exhaustion after a seizure, sometimes the individual is unconscious for 20-30 mins due to it.
What are the emergency protocols for a generalized tonic clonic (grand mal) seizure?
- clear the area to avoid them hitting their head
- place a towel under their head to avoid injury
- do not restrain or place anything in their mouth
- have someone phone EMS
- check they are breathing post-seizure and start CPR accordingly
What is hypoxia?
a condition in which the body or a region of the body is deprived of adequate oxygen supply at the tissue level. Hypoxia may be classified as either generalized (affecting the whole body) or local (affecting a region of the body.)
When are epileptic seizures likely to occur?
They are more likely to occur at rest than during exercise.
If they do occur during exercise it is more likely going to be a prolonged exercise event when other metabolic states might come in as contributing factors.
What are blisters caused by?
Shear force in one or more directions which causes fluid to go to the injury site and settle between the dermis and epidermis of the skin.
Why do bruises occur?
When a compressive blow to the skin damages capillaries below the surface and the area fills with blood to cause ecchymosis.
What are contusions?
They are similar to bruises in that they are caused by blunt trauma that does not break the surface of the skin but they also feature swelling and the formation of a hematoma that could restrict movement/cause pain or temporary paralysis due to nerve compression.
What is a hematoma?
A hard, localized mass of blood and dead tissue that restricts movement, can cause pain and potentially temporary paralysis due to nerve compression.
What are the 5 different breaks that can occur in the skin?
- abrasion (scraping of tissue from a fall against a rough surface)
- incision (clean cut to the skin from a tensile force)
- laceration (jagged tear of skin caused by both shear/tensile forces)
- avulsion (severe laceration with skin torn away from tissue below)
- puncture (penetration of skin by an object)
How do you treat any of the 5 breaks of skin?
Clean the area and irrigate with plenty of water and then apply a dry dressing and direct pressure to help control bleeding.
If the gauze gets soaked through with blood, the PT can apply more gauze without removing the first to avoid ripping off any scab that starts to form.
What shot might a person need to update if they suffer broken skin?
Tetanus
When should a trainer suspect a broken bone?
When there is:
- deformity or angulation from normal position
- pain/tenderness
- grating, crepitus (sound of bones grinding)
- swelling
- disfigurement
- severe weakness and loss of function
- bruising
- exposed bone ends
- joint locked in place
What should a trainer do when they suspect a fracture?
- do not allow victim to move injured part or attempt any weight bearing
- remove clothing that covers injury
- cover any open fracture with a sterile gauze dressing or clean cloth to prevent contamination
- leave protruding ends where they are as pushing them in will increase risk of infection and injury to soft tissues
- splint the limb if they need to be moved or try to prevent it from moving till EMS arrives
When making a splint for a fracture, how long should it be?
It should be long enough to extend past the joints above and below the suspected fracture and be padded to prevent pressure injuries due to contact with hard surfaces and edges.
What are the 3 layers of protective covering beneath the surface of the skull called?
Meninges
What does the meninges do?
Provides 3 layers of protection to the skull, brain and spinal cord and allows venous drainage through vessels that flow in between the brain/spinal cord and through the middle layer called the arachnoid mater.
When the skull is fractured, a clear fluid may form a ‘halo’ or ring effect around any blood pouring out, what is this from?
This is the cerebrospinal fluid that cushions the brain and distributes blunt forces over a larger area.
If there is a fracture at the base of the skull or in the anterior cranial area, where would you expect the cerebrospinal fluid to leak from?
base of skull = ears
anterior cranial fracture = nose
What are the warning signs of concussion?
- amnesia/memory loss
- confusion
- headache
- drowsiness
- loss of consciousness
- impaired speech
- tinnitus
- unequal pupil size
- nausea/vomiting
- balance problems/dizziness
- blurry/double vision
- sensitivity to light/noise
- changes in behaviour/thinking/physical function
What should a trainer do in case of eye injuries, nasal injuries and if a tooth becomes avulsed?
Eye - the victim gets an evaluation from an ophthalmologist
Nasal - the victim is checked for damage to the nasal septum
Tooth - tooth is kept clean and placed in milk/salt water and victim sees a dentist immediatly
What is a cervical strain due to?
The overstretching of the neck musculature such as the paraspinals, upper traps and sternocleidomastoid OR when ligaments are stretched beyond their capacities.
When a nick injury is suspected, should the client follow the trainer with their eyes?
No because this will encourage head movement which needs to be avoided till EMS arrive.
When a neck injury is suspected, the spinal cord may interfere with the phrenic nerve’s signals to the diaphragm - what can this disrupt?
This can disrupt normal breathing.
What type of stabilization should be done until EMS show up in terms of a neck injury?
Manual in-line stabilization which is holding the victim’s head as still as possible.
What is hypoperfusion?
Also known as shock.
This occurs when blood is not adequately distributed in the body and tissues don’t receive the oxygen or nutrients needed for proper function and survival.
What are the 4 major types of shock?
- hypovolemic
- obstructive
- distributive
- cardiogenic
What is Hypovolemic shock?
When fluid is lost as a result of severe dehydration or from severe internal or external bleeding.
What is Obstructive shock?
When a blood clot or other mechanical obstruction does not allow blood to reach the heart.
What is Dsitributive shock?
When vessels are dilated and do not allow normal blood distribution.
What is Cardiogenic shock?
The inadequate function of the heart resulting from a heart attack or CAD.
What are the signs of shock/hypoperfusion?
- restlessness
- anxiety
- altered mental statu
- pale/cool/clammy skin
- fast/weak pulse
- irregular breathing
- nausea
- thirst
Why should you cover someone with a blanket if they are in shock?
Because shock decreases the ability to regulate body temperature.
What are the most concerning bloodborne pathogens to think of when dealing with another person’s blood?
Hepatitis B and HIV
How is Hepatitis transmitted?
By drug injection, contact with mucous membranes or broken areas of skin or casual contact with someone who has Hepatitis B.
When should carries of HIV discontinue exercise?
When their CD4 counts are below 500
What are CD4 cells?
Also known as T4 or T-Helper cells, these are a type of white blood cell that fights infection.
What is a normal C4 range?
500-1500
At a CD4 count of less than 200, someone with HIV is considered to have…
acquired immunodeficiency syndrome (AIDS)
